What if what you thought you knew about Massage was wrong?

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What if what you thought you knew about Massage was wrong?

image of a beetle struggling

How do you know you know what you know?

Massage Mythology

 

As therapists, every time we perform our techniques we also engage in a variety of other ritualistic and protocol-oriented tasks. For example; the client comes into the space, they lay down on the table, you dim the lights, you play soft music, you engage in assessment. The client prepares mentally, they expect to be treated, they look forward to the event, they undress carefully because it’s not their room, they are touched in a way they normally not, they become passive and let you move them around. Each one of these actions has a cognitive, proprioceptive, or experiential value. So how do we know which of these actions, in isolation, is responsible for the outcome? Are any of them? Are some of them? Is it you? Is it them? Is it just a perceived outcome?[divider_flat]

The ancient Egyptians believed that the sun was moved across the sky by the god Kephri, who was the great insect god. In their minds, they connected the movement of the sun to that of a dung beetle moving its ball of dung across the sand. So powerful was their belief that the gods moved the sun that they made scarabs (a totem-carved beetle figure to be worn) that were inscribed for both common people and royalty alike. They also believed that the male beetle fashioned his ball of dung as an egg from which he could spontaneously generate a new beetle. With no need for lady beetles, it gave the beetle the power of life. As a result of this strong belief the scarab became the symbol of life in Egypt. (here is some interesting reading about that). In actuality, what was really happening was the female beetle laying its fertilized eggs inside the dung ball. If you asked an ancient Egyptian how they knew these things to be true, they would likely tell you because they can see it. The sun indeed moves across the sky, and the beetle does roll its dung and new beetles spring from it.[divider_flat]

The modern day mythologies we tell ourselves about care are equally as strong. The attachments we have to fascia, triggerpoints, ‘it’s all connected’, and all the various other modalities all carry weight. Therefore we must be careful not to jump to conclusions just because we were taught it, can see it, or feel it. Seeing and feeling does not mean it is true. The problem arises when we seek to fill in the blanks while only holding part of the picture. So ask yourself daily; what is it I actually know about massage and science rather than what I have been taught. Does the sum of the total add up? Or am I creating more mythology to fill in the blanks.[divider_flat]
The body maintains itself reasonably well with contained self management due to some lovely features like homeostasis and feedback loops of various kinds. As therapists, we can work with those concepts, find ways to be a part of them and use treatments that aid them, but it’s unlikely that change is coming from an entirely external source unless that source is a surgeon or internal medicine. For the most part people get better, or they don’t. As manual therapists we could have a great benefit and place in health care as facilitators, but only if we attribute and analyze our outcomes correctly. The dung beetle has an important place in the ecosystem but it certainly does not move the sun or spontaneously create life. I guess my last note is…let’s not be the dung beetle.

Science Based Massage Therapy the Opposite of BS

Massage therapy and Science Based Massage
Science Based massage, the opposite of BS

 

Well after being so serious I just could not take it any more and this happened. At my clinic we are science based, we are all well educated massage professionals who believe in massage therapy as a science rather than as a fantasy of our own making. In some cases its easier to define what something is NOT than what it is….and this is one of them. Before we go on to what Science Based massage means to me (and yes this definition is what I believe, because it is my blog and my rant) lets take a look at what the meaning of B.S. is (Bull Shit).

I am pulling this definition from Wiki, which is not normally where I get my information, but considering the nature of it, I figured, why not?



 

This article is about the expletive. For other uses, see Bullshit (disambiguation).

Bullshit (also bullcrap) is a common English expletive which may be shortened to the euphemism bull or the initialism BS. In British English, “bollocks” is a comparable expletive, although “bullshit” is more common. It is a slang profanity term meaning “nonsense“, especially in a rebuking response to communication or actions viewed as deceiving, misleading, disingenuous, or false. As with many expletives, the term can be used as an interjection or as many other parts of speech, and can carry a wide variety of meanings.

It can be used either as a noun or as a verb as in the question “are you bullshitting me?”. While the word is generally used in a deprecating sense, it may imply a measure of respect for language skills, or frivolity, among various other benign usages. In philosophy, Harry Frankfurt, among others, analyzed the concept of bullshit as related to but distinct from lying.

Outside of the philosophical and discursive studies, the everyday phrase bullshit conveys a measure of dissatisfaction with something or someone, but often does not describe any role oftruth in the matter.



Pretty much all of the above definitions sum up the way I feel when I hear someone just make stuff up about how massage works. It of course is not always their fault, they may have been passed down bad information from someone else. I am also not talking about peoples spiritual views on connecting to someone, I would not consider that massage.

Lets look at some of the words they used in that quote “rebuking response to communications or actions viewed as deceiving, misleading, disingenuous, or false“. Yep that pretty much sums it up. No matter what the cause of the deception, it is dangerous and damaging. If you work in heath care it is your duty to seek out the truth, or as close as you can get to it, without ego, and keep pursuing it. As massage therapists we spend more one on one time with our clients than almost any provider, and so we can cause some serious problems if we are not careful.

You might ask, “ok so how does massage work then?”. Well, thats the thing, we are not sure exactly, science changes every day. And that is an honest answer. Every time we see a layer deeper into the information we discover new things, so there is a lot still open to explore. We think we know how some of it works, but what we do know for sure is how it DOES NOT work. We could get really specific about the nitty gritty, mico levels, but here I am talking about basic broad high school science concepts like diffusion, osmosis, physics, chemical reactions, electrical conduction etc….The basic rules of high school science apply to the body. Just because it is inside the body does not mean that those rules do not apply. Lets look at more things that it does not do.

It does not magically suck things, move things, push things through the body. Those ‘things’ are governed by the natural biological processes. See ‘osmosis, diffusion, active transport for more information’

It does not instantaneously ‘fix’ things

It cannot cure disease, no matter how much oregano oil you put on

It does not rid you of toxins aka save you from a horrible death by poison because someone who went to school for 500 hrs interviened and gave you a massage…finally

It cannot move bones that have been fused since child hood, like the bones of your head

It cannot make your blood flow rapidly like the river of the Grand Canyon

It is not going to re-align your x, y, z, put your disc back in, correct the spinal curve you have had since child hood

It is not going to make you run faster or clear your body of lactic acid

It does not unravel knots of any kind in the body

There is ALOT massage does not do (that list might get longer as more things come to mind) but the list of what it can potentially help you do is even longer. Your body and brain are in cahoots and they pretty much run the show on what you touch, see, feel, do and experience. Anytime you interact with someone you have the ability to facilitate change via your nervous system, and that is what happens every time you participate in activities like having a massage, going for a run, or even taking a nap. Each activity has a particular response that internally lets the body do what it does…and potentially do it better (or not).  And that is enough for me. I don’t need any huge claims behind it. What being science based is for me is being honest about what I am doing, and pursuing that honesty with my patients daily.

Massage Therapy and Pain (Continued)

decorative imageMassage Therapy and Pain

Working with Clients in the Pain Zone

This is a continuation of the last pain blog which offered some history on pain science and also some really general guidelines on massage therapy and pain.

If your client has no red flags in assessment and you have decided it is safe to touch, working with clients experiencing chronic pain not associated with an injury has its own challenges. For many people, pain has the distinct effect of stopping us from moving, regardless of its cause, and so getting your client back to a place where they feel that they can move can be considered a success. To work safely as a massage therapist with an understanding of this, you are going to want to switch from the treatment model where massage is passively received by a client into one where the client has full control of the experience, both physically and mentally.

First lets look at the physical aspects of a client having control

This can be challenging, especially considering that most massage therapy programs teach massage as a passive activity that is ‘done’ to the client. In this role the massage therapist acts more as a facilitator to touch. Consider that touch is not a one way experience and that every time you gently “rub” a muscle, you also have the ability to instead have that muscle and skin move gently under/against you. If someone is in pain, you have the option of saying “I am going to gently put my hand here on your back, why don’t you try breathing up into that feeling”, or “I will never press harder, why don’t you try pressing gently into me?”, or “I am going to hold your arm gently, why don’t you just tense the muscle a little and then relax or wiggle your fingers?”. There should be a direct relationship to the amount of pain present and the amount of control the client has. The more pain present, the more the patient should be in control of what is happening.

This does 3 things in my opinion:

1. Lowers the anxiety associated with treatment, and the anticipation of pain, and possibly dropping their pain level.
2. Facilitates change in the body by signaling normal function and behavior as the patient moves.
3.Protects you the therapist from stepping over a boundary. If the client has control, they only go as far as they want, and no further. 

I want to be clear that if you are using this kind of treatment with someone who is in pain, you never want to cause pain. Their may be pain associated with the treatment, but it should not be from a new stimulus you are providing, such as pressure or forced movement. The pain associated with treatments of this nature should be caused by a patient moving through their own pain signal. What does that mean? It means that if someone has had long standing neck pain, and they are completely cleared for treatments, with no red flags, you should never aggressively treat with traditional deep massage. Instead I should gently guide the person to the edge of their painful experience and create a safe, controlled, comfortable setting in which they can explore going further-if they choose to do so. If the feeling of pain does not abate, you should, discontinue and refer out, but often reducing the anticipation of pain and giving the client control is the first step in the pain management in Massage Therapy.



How do you do it?

It all sounds pretty simple-give the client the control and they might get past their pain, but its actually a bit more complicated than that, because you don’t want to be randomly trying techniques. I divide my techniques up into graded categories to help me organize the treatments.

  • Low pain– resisted eccentric/concentric contractions and dynamic stabilization, and holding the tissues muscle while the muscle moves beneath
  • Medium pain– gentle active resisted techniques, holding the skin while the muscle moves underneath, simple isolated muscle movements
  • Higher intensity pain– tense and relax exercises for muscles or groups of muscles, breathing exercises that activate accessory breathing muscles

You will notice the different categories of pain could also be explained as acute, sub acute, chronic, or you could use a pain scale to divide them up. The important thing is that you know where you with the person you are treating. I use LP, MP and HP for short hand charting proposes. Lets look again at that client with the neck pain so we can get a better idea of the application of these techniques for the different pain categories.



Lets look at some examples to make things clearer

Client with HP  neck –  This client is afraid to move and has pain on movement of any aspect of cervical spine or upper thoracic, with a history of whiplash. Does not go about normal activities.

Treatment– Is a gentle skin deep gliding massage. The goal is just to get used to the client getting used to touch. Once the client is relaxed we are going to begin graded breathing exercises to see if we can get them to reduce the bracing in the accessory breathing muscles. I isolate a muscle by gently touching it and say “can you make this expand and contract by moving air?” We go though each and every muscle that would be effected by breathing. Then we switch to tense relax and do the same. Isolate the muscle, or muscle group by gently touching it, ask the client to control it by tensing up and then relaxing. I finish by going back to very gentle surface treatment of gliding massage.

Client with MP neck -Client has some movement but feels very limited by their pain. Range of motion is reduced to about half, and some of the ranges are less quality than others. Goes about normal activities but has stopped participating in any sports or anything unnecessary to their day.

Treatment– General massage with light to medium pressure. Once the client is comfortable I begin holding isolated areas skin in areas of pain and asking the client to gently pull away from me. If the client experiences pain we go back to the above treatment. We reverse the technique and this time I isolate muscles and have the client push into me (essentially bowing the muscle) If the clients pain level keeps dropping we then move to full simple isolated muscle movements. I hold the muscle and they run though a full rang of motion. (Video example of type of activity)I often do this by saying “ok now try to squish my fingers with your neck”. I correct any movement where they are recruiting another unnecessary muscle to complete the movement or avoid moving through the whole range. At the end of the treatment we return to gentle massage.

Client with LP neck-This client has pretty much full range of motion, but experiences pain at the end range. In their words “I just feel I can’t get past the final stage of the injury”. They are going about their daily lives, and participating in sports with occasional flairs. (this is the client you should most often be treating and seeing unless you are an advanced practitioner)

Treatment–  A general massage with light to medium pressure. You can use any of the above mentioned techniques to warm the tissues. As the treatment progresses, I move to holding the muscles firmly while they go through a range of motion. If no pain is present I ask the client to gently resist the movement for the selected muscle. (Video example of activity)If still no pain is present, I ask the client to resist with movement and move on to eccentric concentric moments. All of these activities are still gentle (the client need only meet you with enough force to activate the muscle)We end the treatment with the same general massage. If at any point the pain or the tone of the muscle rises, we go back to a previous treatment plan.

Wait!!!

But we have gotten ahead of ourselves…before you can do any of this cool stuff, you have to talk to your client about exactly what you will be doing with them and why you think it is the best choice!!!! And that’s exactly what we will go over next time.

Massage Therapy and Pain

Massage Therapy and Pain, What Does it All Mean?

Massage therapists live in a world of touch. So it is no surprise that the new science that relates to how touch, sensation and pain is processed and experienced would be relevant to massage therapists. This is particularly true since many clients seek out massage therapy for complaints specifically relating to pain.

Pain science in one form or another has been around for years. One of our first understandings of it was provided by Descartes [1], who theorized that pain and physical illness were limited to a nervous system experience, i.e. you hurt your hand and so you feel it. It essentially separated the mind and body experiences.

As our understanding of pain sensation grew, we realized that feeling things was a far more complex process, and that our bodies are filled with different kinds of receptors that relay information, not just one way to process. Melzack and Wall changed [2] our perception further by bringing in the “gait control” theory to our clinical understanding. In this view, when the system is stimulated, it is sent through a ‘gait’ in the dorsal horn of the spinal cord. That gait however can be modulated by some psychological components resulting in a difference in the perception of the stimulus.

Our most current and newest understanding of pain is that of the biosocial understanding of pain. [3] In this model, we have a stimulus of some kind that is relayed to be processed, but at that point many factors such as environmental, social or emotional, might come into play to determine if pain is generated and at what intensity. And from that we see pain as an output of the brain, rather than something that is the result of poor biomechanics or even, in some cases, injury. In other words, pain can stand on its own without us having to find causation in the body.

What does this mean for Massage Therapy?

For a lot of massage therapists, this has left them a little confused as to their role in treatment. If pain is not generated exclusively in the body, what are we treating? If I am not ‘fixing’ a structure or posture, what am I doing? If pain is an output, then why seek physical treatment at all? It could be easy to start feeling a little redundant in the mix of it all, but now more than ever, massage is a viable option to those experiencing pain.

From a massage therapy perspective, the biosocial model of pain is far more inclusive than exclusive. If pain is influenced by thoughts, feelings and emotions, then doing things that feel good have the potential to benefit the client, even from a general treatment perspective. Asking your client “how do you feel?” during treatments, and “was that good for you?” afterwards becomes a relevant way to guide success for generalized treatment. It’s a step towards the clinical world seeing ‘feeling good’ as a part of heath care, rather than a luxury associated with indulgence.  If the body is spending much of its time protecting us by sensing threats around us, we can also help send the message back to the body, that everything is “a ok” (within reason).

Don’t throw the baby out with the bathwater

It would be easy to read the new information coming out about pain and assume that from here going forward massage has only general feel good treatments to offer in the context. Should massage therapists stop treating for specific conditions? The answer is both yes and no. Moving forward with quality treatments is going to have to do with how humble and honest a massage therapist can be with him or her self. And that is no easy task in an industry trying to prove itself as medical professionals. Massage therapists have to accept two truths about their treatments and understanding of them. 1. that they have a limited understanding and education about what they know about the person on their table.  2. That they may never know the answer to why the body has decided to protect itself.

This model does not mean that structural problems don’t exist. The normal rules of physics involving force, friction, leverage and space are still in effect. Bones still break, posture still degrades to bone to bone contact, and fitness plans still ramp up too fast, but a therapist has to be willing to open the door to other possibilities when the evidence does not add up, question it, even when it does, and treat the structural issue as a symptom rather than a cause in some cases.

Pitfalls in Treating Pain with Massage

You may find yourself getting caught in a few traps if your a massage therapist treating people with pain. Operating safely in the biosocial model of pain does have its challenges. If pain is not always associated with injury, then assessing “pain” as a contraindication for treatment may not be the best guide. Without fail, a massage therapist must be able to  assess the signs and symptoms of pain associated with acute injury pain-vs-the signs and symptoms of pain itself. The signs may not always be so clear.  If you are inexperienced, it is always best to refer out so that you can remain safely in the boundaries of “Do No Harm”.  A biosocial pain assessment for a massage therapist looks like this:

Screen Shot 2015-03-29 at 12.47.01 PM

The sooner therapists get comfortable with treating pain, the sooner they can help get their clients comfortable. Next time we will go over the guidelines for talking to your clients about pain to provide some answers about when and how talking to people about their pain is appropriate in the contexts of Massage therapy as health care.

 

 

 

[1][2]R.Melzack, P.Wall. Science, New series, Vol. 150, NO. 3699.Nov, 19 1956 Pain Mechanisms: A new theory Retrieved from https://isle.hanover.edu/Ch14Touch/Ch14GateControlTheory.html

[3] R.J. Gatchel, Psychological Bulletin, Vol. 133, NO 4, 581-624 2007. The Biopsychocial approach to chronic pain: Scientific advances and future directions. Retrieved from http://enniscentre.com/Presentations/Gatchel-Biopsychosocial%20Approach%20to%20Chronic%20Pain.pdf

Body Mechanics Orthopedic Massage, 1 W 34th St, #204, , New York 10001, United States (US) - Phone: 212-600-4808

Orthopedic Massage….What Are We Doing?

So this post is inspired by my frustration at some of the myths that perpetrate the massage industry through poor education, misinformation, poor training and subsequently are passed on to the general public. Orthopedic Massage is a science based practice based largely on evidence. While our understanding of what exactly is happening during treatment sometimes is incomplete, we try very much to keep within the boundaries of plausible science. As new information comes out we adapt and keep moving. Here are some of the tenets my practice as an orthopedic therapist is based on.

1. While we use physical assessment during our intake, that assessment is primarily concerned with postures that avoid pain and general notation of physical differences. Our treatment is not based on fixing, changing or improving posture. Structure does not always follow function. People can have poor posture and no pain or poor posture and pain. Unless a posture has been adopted to avoid pain and gives information about the causality, then it has little bearing on treatment. It is merely something to note. On the same token, imaging also has little information to lend to this people without pain are riddled with so called dysfunction. This does not mean we ignore it, but it is not absolute.

2. Homeostasis happens whether you are there or not. Most conditions are self resolving, we cannot change the body, what we can do is set the ideal conditions for change, and interact with the nervous system in such a way that we try to communicate that the crisis is over.

3. Pain is neurogenic and an output of the brain. Pain is one of the body’s few ways of communications with you, but that communication does not always mean damage. Some of the few areas of research that have been confirmed tell us that touch does help with pain mediation. We touch with the understanding we are not ‘fixing’ but more likely influencing processing.

4. Nothing in the body goes to waste, there are no toxins or buildups of lactic acid that need to be dealt with through manual therapy. Lactic acid is an important chemical necessary for long term metabolism, and even your earwax is an mild insecticide.

5. Other than scar tissue, which is slightly less functional than regular tissue and produced by inflammation, there are no adhesions in the traditional sense that need to be broken down. It does not make sense that our body would just ‘gum up’. The natural movement of the body resolves most issues. Areas that are shortened should be approached from a neural perspective.

6. The body heals itself through it’s natural movements and function. The heart alone is not responsible for pumping all of the blood through the body, muscle pumping also aids, which is why movement is so strongly tied to our health.

7. The likely hood of benefit, is always greater if the body is in control rather than a passive operation.

8. Techniques where you ‘re-damage’ tissues in order to promote healing such as frictions are outdated.

9. Stretching is not actually lengthening muscles, but conditioning them to the feeling of length. In muscle tonicity there is relaxed and contracted. (please see pain in neurogenic)

10. Ice is an analgesic…it is not for swelling. RICE is made for emergency care to help manage pain and fluid soon after injury. There has been some confusion about this lately, as new information has come out the effect of ice on capillary beds. However, if you just got hit in the head with a hockey puck, please follow your protocol of RICE until an emergency worker arrives, nothing about emergency protocol has changed. Inflammation in general is not bad for you, it is part of the natural process of healing. Ice is also contractile so if you are applying ice to something that hurts, think about why your applying it, because it is also contracting the muscles in the area.

And this I am throwing in on principle…you do not need water after a massage, but it is nice!

Marketing based on poor scientific conclusion about manual therapy, that makes the patient think there is something wrong with them that may only be fixed though intervention, is far more damaging that the problems they seek help for. Absolutely patients need a care continuum in their health care that involves manual therapy, but if we are not treating posture, imbalance, adhesions or muscle length, it might be hard to understand what we are doing. And while the question remains open on a biological level as to what is happening step by step, I view my job as an orthopedic therapist as that of a facilitator. I move people in a relaxed state, through the use of skin/muscle stimulation and passive, active and resisted ranges of motions while giving a safe place to explore and educate about mild to medium level pain. For many people this increases their range of motion and decreases their pain on the table, as well as off, which allows them to get back to moving in ways that are normal for them.

Because Orthopedics is mostly concerned with increased ROM, we are looking at measurable results, that bring us away from more CAM practices.

Find out more about Orthopedic Massage in NYC

Strength & Conditioning for the Cyclist

 

By Ivan Garay LMT/CPT

Strength training can improve a cyclist’s performance and protect against injuries. Research on endurance athletes shows that strength training improves the three most important predictors of endurance sports performance[1]: economy (the ability to do a certain amount of work using as small amount of energy as possible), velocity/power at maximal oxygen uptake (How fast you can pedal on your endurance races), and velocity at maximal anaerobic running threshold (How fast you can sprint before burning out at top speed).

When designing a strength training program, you must first focus on correcting any imbalances in posture and movement patterns. The prolonged bent over position on the bicycle and miles of pedaling create common muscle imbalances in cyclist. They include tight/shortened muscles, the calves, psoas, quadriceps, hamstrings, lumbar spine, pectorals, upper trapezius, and neck flexor muscles. Along with these shortened muscles,there are weak/lengthened muscles, the tibialis anterior, gluteus maximus, abdominals, rhomboids, middle and lower trapezius, and neck extensor muscles.

Below is a sample routine that will balance muscles and improve cyclers posture:

First release tight muscles with foam rolling or active stretching:
Calves, psoas, quadriceps, hamstrings, lumbar spine, pectorals, upper trapezius, neck flexor muscles.

Follow by strengthening the weak muscles with resistance exercise:

  • Ankle Dorsiflexion with Cable or Tube Resistance
  • Barbell or Dumbbell Deadlift
  • Bridges
  • Dumbbell Rows with Shoulder Blades Squeezed (this exercises will reduce middle and upper back pain and soreness from long rides)
  • Neck Extension in a Quadruped Position (It will reduce neck pain from prolonged forward head position)
  • Planks
  • Side Planks

Brace your abdominals with every exercise. To perform an abdominal brace, pull your bellybutton toward your spine, tighten your abs without moving your body (as if you were about to be punched in the stomach).

Perform each exercise for 2 sets of 12-20 repetitions for muscular endurance.

Current research recommends that to increase cycling performance heavy strength training at maximal velocity[2] should be performed with multiple leg exercises for periods of greater than 6 weeks [3]. During a cycler’s off-season, high volume strength training should be performed two to three times a week and each exercise should be done for two to three sets for four to ten repetitions. You should rest two to three minutes between sets. Maximal results usually occur after an 8-12 week cycle of training. During competitive season your training volume should be reduced to 1 session a week with a lower volume of exercises but with the same high intensity to maintain strength gained from your off-season program[4].

Pick a heavy weight with each exercise and move as fast as you can during the concentric phase (lifting phase) and slow down during the eccentric phase (lowering phase of the exercise).

Off-Season Routine

  • One-Legged Squat
  • Barbell DeadliftDumbbell lunges
  • Standing Calve Raises
  • Barbell Rows
  • Seated Calve Raises
  • Chin-Ups
  • Bench Press
  • Barbell Shoulder Press
  • Dips
  • Dumbbell curls
  • Back Extensions
  • Planks
  • Side Planks

Competitive Season Routine

  • Barbell Front Squat
  • Standing Calve Raises
  • Barbell Rows
  • Bench Press
  • Dips
  • Dumbbell Curls
  • Planks

[1] http://link.springer.com/article/10.1007/s00421-013-2586-y
See Reference Page for article citation

[2] http://link.springer.com/article/10.1007/s00421-013-2586-y
See Reference Page for article citation

[3] https://www.ncbi.nlm.nih.gov/pubmed/23914932
See Reference Page for Article citation

[4] http://link.springer.com/article/10.1007/s00421-010-1622-4
http://onlinelibrary.wiley.com/doi/10.1111/j.1600-0838.2009.01035.x/abstract;jsessionid=8DA506016E22EA58C549B269A3F70D81.f03t03?deniedAccessCustomisedMessage=&userIsAuthenticated=false
See Reference Page for Article citation

Strengthening and Conditioning for a Marathon

The right strengthening and stretching program is important when preparing for a marathon. Strength training has been shown to improve running economy, prevent injuries, and improve body composition and resting metabolic rates. Strength training is particularly important for older runners. Endurance exercise, like running, does less to protect against age related loss of lean muscle tissue than strength training.

When training for a race runners should perform one to two full-body strength sessions per week. Your workouts should be staggered around your key running workouts for the week. Avoid combining your strength workout with a hard speed session or long run on the same day. Research shows it could compromise your running workout and recovery[1]

Your strengthening routine should focus on two goals. First you must focus on correcting any imbalances in your movement patterns like over-pronation or over-supination. Read my last blog post on Plantar Fasciitis for the right exercises and stretches. Research has shown that a 1:1 strength ratio between your hamstrings and quadriceps is related to optimal running economy[2]. When performing leg exercises you can compare how much weight you can lift on the leg extension exercise versus leg curls. You need to strengthen the weaker of the two muscles. Most people have stronger quadriceps than hamstrings and will usually do only the leg curl, instead of both leg curl and leg extension exercises in a workout.

In addition to corrective exercises, your workout should aim at overall strengthening throughout the body to improve running economy and endurance muscle fibers. The following is a sample workout that incorporates both :

Lower Body

If you over-pronate during running do:
-Ankle Inversions with dorsiflexion using resistance tubing,
If you over-supinate, during running do
-Ankle Eversions with plantarflexion using resistance tubing

If your Quadriceps are stronger than your hamstrings do
-Leg Curls

If your Hamstrings are stronger than your Quadriceps do
-Leg Extensions
-Hip Adduction
-Hip Abduction
-Dumbbell Front Squat
-Barbell Deadlift

Upper Body

-Bench Press
-Dumbbell rows
-Dumbbell press
-Barbell Curls
– Planks(hold 30-60 seconds)
-Side Planks (hold 30-60 seconds)
-Do 2 sets of each exercise of 8-12 repetitions

For each upper and lower body exercise start with a weight heavy enough to allow you to reach 8 repetitions per set. Try to increase the reps every week. Once you can perform 12 repetitions with a certain weight, you can increase the load enough to allow you to do 8 repetitions again. Use the routine alongside your running training 1 to 2 days a week.

Provided by Ivan Garay LMT CPT
References

Eur J Sport Sci. 2014;14(2):107-15. doi: 10.1080/17461391.2012.726653. Epub 2012 Oct 3.
The acute effects intensity and volume of strength training on running performance.
Doma K1, Deakin GB.

Journal of Strength & Conditioning Research:
doi: 10.1519/JSC.0000000000000376,
Post Acceptance: January 28, 2014
Relationship Between Functional Hamstring: Quadriceps Ratios and Running Economy in Highly Trained and Recreational Female Runners.
Sundby, Øyvind Heiberg; Gorelick, Mark

[1] http://www.ncbi.nlm.nih.gov/pubmed/24533516
See references for specific citation information

[2] http://journals.lww.com/nsca-jscr/Abstract/publishahead/Relationship_Between_Functional_Hamstring_.97501.aspx
See References for specific citation information

Running Season and Treating Plantar Fasciitis

Exercises for Plantar Fasciitis

Plantar Fasciitis is one of the most common foot complaints. Technically what is happening is the plantar fascia is being over stretched or over taxed
Beret Kirkeby, “Treating Plantar Fasciitis”

plantar

Exercise for plantar fasciitis should reduce excessive strain on the plantar fascia and correct biomechanical faults that contribute to plantar fasciitis. Common biomechanical faults include over-pronation, flat feet, a tight Achilles tendon (especially from tight soleus muscles), excessive weight, and a high-arched foot. These imbalances are corrected with the right mix of stretching and strengthening exercises that bring the foot and ankle into correct functional alignment and movement. First, a general exercise routine for all people suffering from plantar fasciitis will be explained; followed by corrective exercise routines for specific common biomechanical imbalances.

General Routine

Before discussing targeted corrective exercises, most everyone with plantar fasciitis will benefit from relieving the strain from a tight Achilles tendon.  But because the body works as a whole, it’s important to not only stretch/work the muscle that directly attach to the Achilles tendon, but also the rest of the posterior chain muscles. (please see link for graphic) Treatment would start at the gluteal muscles, hamstrings, and then the calf. The figure below is the posterior chain of muscles that connect to the Achilles tendon. If you are seeking treatment for plantar fasciitis, it is important to note that it it begins in the hips. It is a common misunderstanding that it is the feet causing the issue. While the feet clearly play a role, the focus of treatment is not specifically the feet unless you are utilizing orthotics or working on foot mobility.

achilles-tendon

Imbalance or dysfunction in any segment of the posterior chain can produce excessive tightening of the Achilles tendon, so it is important to stretch each segment individually first and than end with a full posterior chain stretch like the Downward Dog yoga pose.
The following exercises are recommended in this order:

First, Stretch the Soleus (lower calve)soleus

Second, Stretch the Gastrocniemius (upper calve)
upper-calve

Third, Stretch the Hamstrings
hamstrings
Fourth, Stretch the Erector Spinae
erector-spinae

End with the Downward Dog Pose (will also treat the gluteus muscles)
downward-dog-pose

It’s best to use the Active-Isolated Stretching technique on each segment and end with holding the Downward Dog pose for 30-60 seconds. If you are unfamiliar with Active-Isolated Stretching, visit: http://www.stretchingusa.com/active-isolated-stretching

Exercises for Specific Biomechanical Faults

To understand biomechanical faults, let’s first look at the walking cycle. In a perfect walking stride, the person’s arch elevator muscles of the leg (tibias anterior, peroneus longus and tibialis posterior) work in perfect harmony with the plantar-flexors (gastric, soleus, etc.) to absorb, distribute and release stored kinetic energy. On heel strike, the arch elevators must fire eccentrically to decelerate and dissipate ground reaction forces via foot pronation and internal tibial rotation.

As the foot transitions from midstance into push-off, the toes begin to dorsiflex causing activation of the plantar fascia and associated muscles.

But if the muscles of the leg and ankle are imbalanced, the forces acting on the foot and ankle are not evenly distributed. This often results in excessive strain to the plantar fascia. Over pronation, a common problem causes excessive strain on the plantar fascia and often leads to flat feet.

Over Pronation and Flat Feet
pronation

If you are over pronating your plantar flexor muscles are often stronger and tighter than your arch elevator muscles. The arch elevator muscles of the leg (tibias anterior, peroneus longus and tibialis posterior) need to be strengthened. The following two exercises help to strengthen these weaker muscles.

ankle-inversion

An elastic band, rubber tubing, or cable machine are all good choices to provide resistance. Start the ankle inversion exercise in neutral and fully invert your foot slowly. Do 3 sets of 20 to 30 reps. The second exercise is for flat feet:

excersice-pronation

Sit on a chair so that your knees are at an approximate 90-degree angle with your feet on the ground. You’ll need a smooth floor so that the towel will glide easily. Spread the length of the towel in front of you and sit with your back straight and bare foot flat on the edge of the towel. The short end of the towel should be against the legs of the chair. Without moving your heel, contract your toes to bunch up the towel and draw it toward you (as shown) until you have done 2 sets of 10-20 repetitions of toe contractions or run out of towel. As the exercise becomes easier over time, begin adding a light weight to the end of the towel.

Excessive Supination and High Arch

ankle-eversion

Like the inversion exercise, a Thera-Band, tubing or cable machine will work well. Do 3 sets of 20 to 30 reps and move slowly throughout the range of motion. The second exercise for high arches involves a tennis or golf ball to release the muscles on the plantar surface of the foot.

ball-stretch

Place the ball under your foot and move the ball back and forth 20-40 times. Repeat on other foot (Note: roll only on the non-painful part of the arch, if the entire surface of foot is painful, avoid this exercise).

If you have any questions or comments on this topic, make sure to post them on our blog or email us directly.

Fitness information provided by Ivan Garay, a personal trainer. To book an appoinment for personal training, please contact his website: http://ivangaray.massagetherapy.com/

TMJ Home Care

We have had so many requests for this and finally have put it together. One of the things we really stress with clients is that for chronic pain conditions WE DO NOT WANT TO SEE YOU. We really want you to get better. Getting better comes from work on our part and on yours. We put together this home care information for TMJ to help you out between visits. Please remember that if you are unsure of your condition, visit a doctor and get a proper check up. If you have any questions for us we are always available.